What your friend is experiencing in a small medical practice is less a function of the size of the office, and more a function of the physician's lack of managerial skills. There are small practices where the levels of communication, trust, and respect are high, and there are huge practices where backbiting, gossip, and teasing are standard operating procedures.
If your friend is dissatisfied with her work situation and feels that she has done all that she can to correct it, she should consider making a move. However, rather than automatically eliminating small practices from her job search, she should try to check out the next employment situation very carefully, regardless of size.
Since leadership sets the climate, tone, and atmosphere of an organization, it will be important for her to meet with departmental leadership in a large practice, and topside leadership in a small one. She should also try to spend time with the other employees. If possible, she should try to have several trips to the doctor's office, as it has been found that multiple visits to a potential employer can be very helpful in the decision-making process.
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